MEDICARE: ROBERT YAN DDS P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1902667504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT YAN DDS P.C.

Provider Business Mailing Address
First Line	:	1658 80TH ST APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1624
Country	:	US
Telephone Number	:	917-285-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4532
Country	:	US
Telephone Number	:	718-521-4603
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT YAN
Credential	:	DDS
Telephone Number	:	347-403-9359

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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